Cancer characteristics, prognoses and mortality of colorectal cancer in patients with Crohn's disease - A Danish nationwide cohort study, 2009-2019.

Martha Pollen Johansen, Mads Damsgaard Wewer, Peter-Martin Krarup, Johan Burisch, Andreas Nordholm-Carstensen
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Abstract

Background/aims: Investigate the impact of Crohn's Disease (CD) on patient- and cancer characteristics and mortality in patients with colorectal cancer (CRC).

Methods: A nationwide cohort study of patients diagnosed with CRC in Denmark from January 1st 2009 to December 31st 2019. Cancer characteristics were retrieved from the Danish Colorectal Cancer Group registry and merged with a nationwide cohort for inflammatory bowel disease. The main outcome was all-cause mortality in CRC patients with and without CD, comparing CD patients with CRC with CRC in the general population, evaluated by adjusted Cox regression analysis and propensity score-matching.

Results: Of 38 077 CRC patients, 245 (0.6%) had CD. The median age at cancer diagnosis was 69 years (interquartile range (IQR): 60-76) for CD-CRC and 71 years (IQR: 64-78) for non-CD CRC (p<0.001). Most cancers were located in the right colon in the CD-CRC group. CD was not associated with increased all-cause mortality in the cohort overall. CD patients with colon and rectal cancer and UICC stage III tumors had a higher mortality rate in multivariate- (hazard ratio (HR) 1.60 (confidence interval (95%CI)1.13-2.27), p=0.008) and univariable analyses (HR 1.57 (1.11-2.22), p=0.011). In the propensity score-matched analysis, CD was not associated with increased mortality for colon (HR 1.06 (0.82, 1.36), p=0.7) or rectal cancer (HR 1.25 (0.79, 1.98) p=0.3).

Conclusion: This nationwide study identified distinct features of colon and rectal cancer in patients with CD that have implications for the timing of diagnoses, disease course and mortality specifically in UICC stage III disease.

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克罗恩病患者结直肠癌的癌症特征、预后和死亡率 - 2009-2019 年丹麦全国性队列研究。
背景/目的调查克罗恩病(CD)对结直肠癌(CRC)患者的患者特征、癌症特征和死亡率的影响:方法:对2009年1月1日至2019年12月31日期间丹麦确诊的CRC患者进行全国性队列研究。癌症特征来自丹麦结直肠癌小组登记处,并与全国炎症性肠病队列合并。主要结果是有 CD 和无 CD 的 CRC 患者的全因死亡率,将有 CD 的 CRC 患者与普通人群中的 CRC 患者进行比较,通过调整后的 Cox 回归分析和倾向得分匹配进行评估:在 38 077 名 CRC 患者中,有 245 人(0.6%)患有 CD。CD-CRC 癌症确诊时的中位年龄为 69 岁(四分位间距(IQR):60-76),非 CD CRC 癌症确诊时的中位年龄为 71 岁(四分位间距(IQR):64-78):这项全国性研究发现了 CD 患者结肠癌和直肠癌的不同特征,这些特征对 UICC III 期疾病的诊断时机、病程和死亡率都有影响。
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